ArticleSurgical endoscopy2013
The multiphasic learning curve for robot-assisted rectal surgery.
Article in Surgical endoscopy, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 80 papers, 7 of them syntheses that pooled it.
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Who cites it
80 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- The learning curve of laparoscopic, robot-assisted and transanal total mesorectal excisions: a systematic review.Surgical endoscopy · 2022Pooled it
- A systematic review and meta-analysis of robotic-assisted transabdominal total mesorectal excision and transanal total mesorectal excision: which approach offers optimal short-term outcomes for mid-to-low rectal adenocarcinoma?Techniques in coloproctology · 2021Pooled it
- Functional outcomes after laparoscopic versus robotic-assisted rectal resection: a systematic review and meta-analysis.Surgical endoscopy · 2021Pooled it
- A systematic review of the learning curve in robotic surgery: range and heterogeneity.Surgical endoscopy · 2019Pooled it
- Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a systematic review and meta-analysis.International journal of colorectal disease · 2018Pooled it
- Learning curve in robotic rectal cancer surgery: current state of affairs.International journal of colorectal disease · 2016Pooled it
- Laparoscopic natural orifice specimen extraction-colectomy: a systematic review.World journal of gastroenterology · 2014Pooled it
- Impact of robotic platform transition on short term outcomes in colorectal cancer surgeries.Journal of robotic surgery · 2026Observational
- Comparing the Oncologic and Surgical Outcomes of Laparoscopic Versus Robotic Rectal Cancer Surgery: A Narrative Review.Cancers · 2026Review
- Colorectal Cancer Surgery: Laparoscopic vs. Robotic Approaches-A Review of the Literature.Journal of clinical medicine · 2026Review
- Initial adaptation to robotic rectal cancer surgery using the hinotori surgical robot system: a CUSUM analysis of certified proctor surgeons.Journal of robotic surgery · 2026Article
- Article
- Comprehensive evaluation of the learning curve for submucosal tunneling endoscopic resection.Surgical endoscopy · 2026Article
- Learning Curve of Da Vinci Xi Robotic Low Anterior Resection: A Cumulative Sum Analysis of a Single High-Volume Surgeon.Journal of clinical medicine · 2026Article
- Impact of the learning curve on the outcomes of robotic surgery in obese patients with rectal cancer.Surgery today · 2026Article
- Learning curve in robotic rectal cancer surgery: A national two-centre study.Journal of minimal access surgery · 2025Article
- Review
- Learning Curve for Robotic Colorectal Surgery.Cancers · 2024Review
- Impact of proficiency in the transcatheter aortic valve implantation procedure on clinical outcomes: a single center retrospective study.BMC anesthesiology · 2024Article
- Hospital learning curves for robot-assisted surgeries: a population-based analysis.Surgical endoscopy · 2024Article
20 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRobotic rectal surgery is gaining in popularity. We aimed to define the learning curve of an experienced laparoscopic colorectal surgeon in performing robot-assisted rectal surgery. We hypothesized that there are multiple phases in this learning process.
methodsWe performed a retrospective analysis. Consecutive patients who underwent robot-assisted rectal surgery between July 2007 and August 2011 were identified. Operating times were analyzed using the CUSUM (cumulative sum) technique. CUSUMs were model fitted as a fourth-order polynomial. χ(2), Fisher's exact, two independent samples t test, one-way ANOVA, Kruskal-Wallis, and Mann-Whitney tests were used. A p value of <0.05 was considered statistically significant.
resultsWe identified 197 patients. The median (range) total operative, robot, console, and docking times (min) were 265 (145-515), 140 (59-367), 135 (50-360), and 5 (3-40), respectively. CUSUM analysis of docking time showed a learning curve of 35 cases. CUSUM analysis of total operative, robot, and console times demonstrated three phases. The first phase (35 patients) represented the initial learning curve. The second phase (93 patients) involved more challenging cases with increased operative time. The third phase (69 patients) represented the concluding phase in the learning curve. There was increased complexity of cases in the latter two phases. Of phase 1 patients, 45.7% had tumors ≤7 cm from the anal verge compared to 64.2% in phases 2 and 3 (p = 0.042). Of phase 1 patients, 2.9% had neoadjuvant chemoradiotherapy compared to 32.7% of patients in phases 2 and 3 (p < 0.001). Splenic flexure was mobilized in 8.6% of phase 1 patients compared to 56.8% of patients in phases 2 and 3 (p < 0.001). Median blood loss was <50 ml in all three phases. The patients in phases 2 and 3 had a longer hospital stay compared to those in phase 1 (9 vs. 8 days, p = 0.002). There were no conversions.
conclusionAt least three phases in the learning curve for robot-assisted rectal surgery are defined in our study.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.